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Yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx |


Profile of Qualifications


  • Results-driven Leader possessing a broad knowledge of Worker s Compensation claims processing.
  • Recognized for strong problem-solving skills with an ability to increase efficiency and resolve issues in a timely manner.
  • Excellent interpersonal communication skills, key to establishing rapport / trust and maintaining positive relationships.
  • Consistently achieved and exceeded set objectives / goals.


Technical Proficiencies





  DOS System



  Sedgwick Juris System

  ISO Claim Search System

  MS Office Suite


Professional Synopsis


Delta Associated Investigation, Inc., Buford, GA 2015-2017


  • Fulfilled key leadership position within an agency responsible for conducting fraud investigations and background checks.
  • Used strong leadership skills to conduct in-depth training for Case Managers.
  • Formed positive relationships with clientele; maintained detailed client records and handled special requests.
  • Leveraged strong communication skills to serve as a liaison between Adjusters and Case Managers; simplified complex claims concepts.
  • Provided direct support to Human Resources Director and Case Managers in various capacities.
  • Strengthened existing industry knowledge by completing continuing education courses.
  • Thoroughly reviewed data to ensure quality control throughout all operations; created daily log to ensure correct alignment of Investigators and cases.
  • Properly delegated cases to Investigators; compiled pertinent information.
  • Responsible for handling various financial operations, including collection of unpaid bills and accounts receivable issues.
  • Demonstrated an ability to interact cohesively with executive team.


Law offices of Humberto Izquierdo, Jr. Esq., Cumming, GA 2013-2015

Claims Director

  • Successfully handled claims across 3 states; conducted in-depth interviews, compiled data and educated clients on Worker s Compensation / insurance processes.
  • Used strong leadership skills to conduct training for Legal Assistants.
  • Increased case load from 60 pending Worker s Compensation files to 200+; independently maintained 40+ files.
  • Contributed extensively to record-breaking collection of $1M+ in annual legal fees.
  • Properly filed associated documents with appropriate state entities.
  • Conducted in-depth legal research, as well as extensive interviews with industry experts.
  • Maintained open lines of communication with Insurance Adjuster.
  • Responsible for trial preparation; successfully compiled information, prepared motions, drafted demand letters and created settlement proposals / statements.
  • Demonstrated strong organizational skills while maintaining detailed medical records and billing information.
  • Performed on-site inspections of vehicles.


Yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx |


FCCI Insurance Group 2011-2015

Senior Claim Examiner- Field Adjuster

  • Fulfilled key investigation role, compiled claimant information and thoroughly reviewed data to verify coverage.
  • Exceeded objectives by 135%; successfully assigned 152 claims within a 12-month period while maintaining a quality audit score of 90%+.
  • Attended mediations and depositions; properly recorded and submitted key information
  • Maintained adherence to all regulations.
  • Appropriated assigned claims to Broker and defense counsel; used strong legal knowledge to provide recommendations regarding claims resolution.
  • Educated employees on Worker s Compensation process.


Sedgwick Claim Management Services; Senior Claim Examiner III - Kroger Account 2010-2011

AIG Domestic Claims-Chartis Insurance Company; National Accounts Claims Adjuster 2004-2010

Travelers Insurance Co., Alpharetta, GA; Claims Resolution Adjuster 1992-2003


Education & Professional Development


Worker s Compensation License, State of Georgia

John Maxwell s Leadership Conference in Orlando Florida

Accounting Coursework Completed, Georgia State University, Atlanta, GA




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